US8097040B2 - Osteosynthesis modular prosthesis, particularly for humerus osteosynthesis - Google Patents

Osteosynthesis modular prosthesis, particularly for humerus osteosynthesis Download PDF

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Publication number
US8097040B2
US8097040B2 US11/920,753 US92075306A US8097040B2 US 8097040 B2 US8097040 B2 US 8097040B2 US 92075306 A US92075306 A US 92075306A US 8097040 B2 US8097040 B2 US 8097040B2
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Prior art keywords
prosthesis according
humerus
prosthesis
coupling
cup
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US20090105838A1 (en
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Enrico Russo
Raffaele Russo
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Da Vinci Srl
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Arthrex Inc
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Assigned to DA VINCI S.R.L. reassignment DA VINCI S.R.L. ASSIGNMENT OF ASSIGNORS INTEREST (SEE DOCUMENT FOR DETAILS). Assignors: RUSSO, ENRICO
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    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
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    • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
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    • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
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    • A61F2310/00005—The prosthesis being constructed from a particular material
    • A61F2310/00011—Metals or alloys
    • A61F2310/00023—Titanium or titanium-based alloys, e.g. Ti-Ni alloys

Definitions

  • the present invention relates to an improved osteosynthesis modular prosthesis, particularly for humerus osteosynthesis.
  • the invention concerns a modular prosthesis that can be applied for humerus osteosynthesis, permitting recover of damaged bone tissue and its vascularization.
  • humerus is a longitudinal bone forming arm skeleton, and is articulated with scapula, radio and ulna. It has a substantially cylindrical shape in the diaphyseal portion, while in its upper part provides a head, inserting within the glenoid cavity.
  • a “narrowing”, known as anatomical neck is present at the base of the head.
  • Prostheses permitting replacing humerus head are usually endo-prosthesis, at least practically penetrating within the humerus diaphyseal channel. Further, they completely replace the humerus epiphysial portion, even in fractures where at least part of the bone tissue could be recovered or re-used, particularly, for example, for young patients.
  • humerus bone upper end head is replaced by a metallic sphere mounted on a support.
  • a polyethylene or metallic coating can replace glenoid cavity of scapular bone.
  • the above support is usually comprised of a stem, introduced within the humerus diaphyseal portion. Said sphere, or metallic hemi-sphere, replacing the humerus head, is then fixed at the stem upper end by fixed joint or screw.
  • stem element is fixed to the humerus only by the inner walls of the diaphyseal channel digged by the surgery. Therefore, for example for osteoporosis tissues, anchoring is often not sure, thus requiring the use of acrylic cement.
  • this kind of prosthesis in any case requires removal of the bone tissue. Furthermore, it cannot be used universally. Thus, its dimensions and proportions must be often adapted case by case.
  • a further problem of the above solutions is that they generally do not permit recomposition of the elements in case of multiple fractures.
  • a first diaphyseal fragment while others are epiphysial fragments.
  • epiphysial fragments generically provide two fragments at the base of the humerus head, in correspondence of the surgical neck, and a further fragment represented by the humerus head, suitable to insert within the glenoid cavity.
  • Object of the present invention is therefore that of suggesting a prosthesis modular and osteosynthesis prosthesis system suitable to be used in most cases of humerus epiphysial fractures, permitting the most recovery of bone tissue.
  • a second object of the present invention is that of permitting reconstruction of large and small tuberosity and preserving humeral head by original cartilage.
  • a third object of the present invention is that of permitting application of the above mentioned system in most number of cases of humerus proximal bone reconstruction and of the glena complementary part.
  • an improved osteosynthesis modular prosthesis particularly for humerus osteosynthesis, characterised in that it comprises a cup element having a convex surface suitable to be introduced within a bone cavity, particularly within the humerus glenoid cavity, and having a concave surface suitable to contain and keep joined all the bone fragments, particularly fragments of humerus epiphysial part, permitting vascularization and the consequent recovery of bone tissue, a stem element suitable to be introduced within a diaphyseal channel, particularly within humerus diaphyseal channel, a coupling element, and coupling means suitable to fix ends of said coupling element respectively at said cup element and at said stem element.
  • said coupling element can provide a curvature corresponding to the surgical neck profile.
  • said coupling means can fix said coupling element with the base of said cup element or with the concave surface of said coupling element.
  • said coupling means can be comprised of a cavity, and of an element suitable to engage with said cavity, said element preferably having a frusto-conical shape.
  • said cavity can be comprised of a shape memory material and/or by titanium alloy and/or titanium.
  • said stem element can have a cylindrical shape.
  • said stem element can have a conical shape.
  • said prosthesis can comprise containment means that can be comprised of a screw suitable to couple with the concave surface of said cup element, said cup element comprising a threading on its concave surface.
  • said containment means can comprise a band suitable to tighten said epiphysial end, particularly humerus head.
  • said band can be comprised of memory shape material and can provide a through hole, though which said screw can be passed.
  • said containment means can comprise a wire having a first end fixed to the concave surface of said cup element and a second end fixed to a needle, so that said needle can be passed through the bone tissue and fixed to the humerus, maintaining bone fragments joined, particularly humerus epiphysial part fragments, cutting said wire and blocking the same by blocking means in the desired position.
  • said wire can be a metallic wire.
  • said containment means can comprise at least a wire, suitable to be introduced within the bone tissue, and blocking means, suitable to block said at least a wire in the desired position.
  • said at least a wire can have a threading on at least an end.
  • said blocking means can comprise jaws, preferably comprised of metal and/or at least a plate and at least a screw.
  • said prosthesis can comprise anti-sliding means, provided on the lateral surface of said stem element, said anti-sliding means being suitable to create friction with the inner surface of said humerus diaphyseal channel.
  • said anti-sliding means can comprise a paste and/or a further band, preferably comprised of memory shape material.
  • said anti-sliding means can comprise acrylic cement.
  • said stem element can be comprised of an inner element and of an outer element, said outer element being suitable to be fixed within said diaphyseal channel, particularly humerus diaphyseal channel.
  • said outer element can have a cylindrical shape.
  • said stem element can comprise fixing means for fixing said inner element and said outer element, and said fixing means can comprise a threading on said inner element coupling with a corresponding threading on the inner surface of said outer element, so that when said inner element is threaded within said outer element, introduction depth can be adjusted.
  • said fixing means can comprise a fixing material, such as acrylic cement.
  • said prosthesis can comprise a support element, suitable to be introduced at the base of the bone damaged epiphysial end, particularly at the humerus head base, said support element being integral with said coupling element or is an integral part of the same, and it can be coupled with said cup element.
  • said support element can have a polyhedral shape, e.g. a parallelepipedal or triangular pyramid shape
  • said support element can be comprised of a plurality of rods, arranged as the corners of a polyhedron.
  • said support element can provide openings for realising guides for containment means and/or fixing means.
  • said cup element can be applied within said bone cavity.
  • an osteosynthesis support element particularly for humerus osteosynthesis, suitable to be used as prosthesis, said prosthesis comprising fixing means and like, characterised in that it is comprised of a plurality of rods, arranged as the corners of a polyhedron, so as to permit possible passage through its volume of fixing means for said prosthesis.
  • stem element suitable to be used as prosthesis characterised in that it is comprised of an inner element and of an outer element, said outer element being suitable to be fixed within said diaphyseal channel, particularly humerus diaphyseal channel.
  • FIG. 1 shows typical humerus epiphysial fractures
  • FIG. 2 shows a schematic section of humerus wherein a typical anatomical curvature
  • FIG. 3 shows an exploded section view of humerus modular prosthesis according to the present invention
  • FIG. 4 shows a prosthesis according to FIG. 3 placed on a humerus
  • FIG. 5 shows a second embodiment of the prosthesis according to the present invention
  • FIG. 5 a shows a section view of the shaft on which a spiral band is applied for fixing stem element to the humerus bone tissue
  • FIG. 6 shows a first embodiment of a prism shaped support element
  • FIG. 6 a shows a second embodiment of the support element
  • FIG. 7 shows a second embodiment of the prosthesis according to the present invention.
  • FIG. 1 it is possible observing the parts where statistically it has been noted that humerus 1 fractures. Analysing the figure it is evident that often, obviously if bone tissue, age and other specific features permit it, it is possible recomposing fracture, thus parts of the head 2 , of surgical neck 3 and 4 and diaphysial 5 .
  • a prosthesis that can be substantially adapted to all fractures and that can be comprised of a lower number of modular elements, as well as permitting an anatomical reconstruction promoting reconstruction of individual anatomic orientation of the humerus head.
  • above prosthesis is mainly comprised of three elements: a cup 7 , a stem element 8 and a bridge or coupling element 9 .
  • the latter is suitable to couple by its ends with said cup 7 and said shaft 8 .
  • Cup 7 has a concave shape. It has such a curvature to permit introduction of convex surface within glenoid cavity. Obviously, its measure and dimension will be a function of the patient anatomy.
  • Concave surface is suitable to receive and contain fracture bone fragments, permitting at the same time to keep them joined after the fracture recomposition.
  • Stem element 8 that is introduced by surgery within the humerus diaphysial channel can have a cylindrical or conical shape, according to the fixing needing, and that can have openings for fixing the same without cement (by screws).
  • Said bridge 9 is provided with coupling means 10 , 11 , suitable to permit fixing to the stem element 8 and to the cup 7 , respectively, as it will be described in greater detail in the following.
  • FIG. 4 shows application of prosthesis according to the present invention to a humerus head 2 with a multiple fracture.
  • Stem element 8 is introduced within the humerus diaphyseal channel 5 .
  • Bridge 9 is coupled with said stem element 8 and said cup 7 by said means 10 , 11 .
  • bridge 9 curvature is an anatomical constant, so that it is necessary providing a limited number of bridge element to adapt prosthesis to every anatomy.
  • Cup is maintained in its position by bridge 9 , thanks to its concave surface. This permits containing fragments of fracture permitting vascularization of bone tissue and its restoring.
  • FIG. 4 also shows two further containment elements, particularly a screw 12 and a band 13 .
  • Said screw 12 can be introduced in the rear part of the humerus head 2 , coupling with a threading 14 realised on the concave surface of said cup 7 .
  • Band 13 is comprised of a shape memory alloy. It promotes coupling of the fracture fragment. It is directly applied on the bone and is fixed on the screw 12 head.
  • a projection on the concave surface of the cup 7 in spite of screw 12 and band 13 , and a flexible wire fixed to said projection (not shown in the figures).
  • Said projection can be made integral with the diaphysial cortical, by tightening the wire passed through a suitable hole and fixed to the humerus. Once said wire is passed through bone tissue, connecting and fixing its parts, in order to recomposing the fracture. Wire is then cut, disposing the needle. Free end of the wire is then fixed to the humerus by standard fixing means, such as plates and like.
  • FIG. 5 shows a second embodiment of the present invention.
  • shaft 8 comprises a hollow cylinder 8 ′ suitable to be introduced within the humerus diaphysial channel. This permits a higher mounting simplicity and replacing of the same prosthesis.
  • Fixing of shaft 8 within cylinder 8 ′ can occur by screwing. This permits adjusting depth of introduction.
  • Coupling means 11 are preferably comprised of a housing 11 ′, obtained on the cup 7 edge, and an element 11 ′, connected, at one end of the bridge 9 and suitable to engage with said housing 11 ′.
  • Said housing 11 ′ is comprised of shape memory material, so as to fix with element 11 ′′.
  • Said housing 11 ′ can be also comprised of titanium alloy, or any other material.
  • FIGS. 6 , 6 a and 7 A further embodiment of the present invention is shown in FIGS. 6 , 6 a and 7 .
  • FIGS. 6 and 6 a show support structures 15 and 15 ′, that in the embodiment of FIG. 6 has the shape of a parallelepiped with triangular base, to be inserted under the humerus head 2 .
  • Said support structure 15 is comprised by an alloy network structure, wherein it is possible providing only elements along the main corners. Therefore, said prism 14 is hollow.
  • Said support structure 15 permits replacing fragments at the base of the head 2 , when they cannot be recovered, when bone fragments are much damaged or squashed, and in any case supporting humerus head.
  • the above support structure 15 is thus used as additional support. In other words, said support structure 15 is placed under the cup 7 , if necessary.
  • Said osteosynthesis support structure can be advantageously used alone for particular fractures of humerus osteosynthesis.
  • Support structure 15 ′ of FIG. 6 a has a more complex shape, to be possibly used for more serious fractures.
  • it is provided a network and windows 15 ′′ aligned each other, in order to permit guided passage of containment screws.
  • Said structures 15 or 15 ′ permit replacing fragments at the base of the head 2 , when they cannot be recovered, with bone fragments much damaged or squashed, and in any case supporting the humerus head.
  • Above-mentioned structures 15 or 15 ′ are used as additional support. In other words, said structures 15 or 15 ′ are placed under the cup 7 , if necessary.
  • Network structure permits using both the bridge 9 and screws 12 and band 13 . particularly, screw 12 can also completely cross it, in case support structure 15 , permitting its screwing with threading 14 .
  • support structure 15 preferably a triangular support structure, permitting supporting both large and small tuberosity, and after having positioned humerus head, from which cartilage has been removed, it is possible implanting, using said support structure 15 , possibly integral or integrating the coupling element 9 .
  • Said support structure 15 thus permits reconstructing both bone proximal tertius and making a prosthesis of the partly destroyed cephalic prosthesis, with a prosthesis with a very small surface.
  • support element 15 preferably comprised of titanium, represents a small stem occupying only meta-diaphysis on which cup element 7 can be implanted.
  • Said cup element 7 can have central or coupling means 10 - 11 , or they can be offset of few millimeters, such as a frusto-conical implant of about 3-4 cm, suitable to be fixedly coupled with a corresponding cavity realised on support elements 15 with a different dimension suitable to receive the same. In this way it is possible implanting a surface prosthesis on a fracture by the original technique of reconstruction.
  • Said structure 15 or 15 ′ can be crossed by and fixed to said cylindrical stem 8 with its distal and proximal portions holed so as to be used as a nail blocked for treating plural-fragments fractures of humerus head 2 .
  • FIG. 7 shows the use of parallelepiped 15 .
  • it is in any case placing said parallelepiped 15 , using it as the sole prosthesis element, always at the base of the humerus head, as support of the same bone and not of the prosthesis cup 7 .
  • threaded or not wires of fiches 16 are applied, passing through the humerus head 2 . they are fixed by anchoring means such as jaws 17 , or jaws and plates 18 , fixed by screws 19 .
  • said wires or fiches 16 can pass through the parallelepiped 15 .
  • a further embodiment of the present invention provides that support element 15 is integral with bridge 9 , or is an integral part of the same. In this case, support element 15 is not a network.
  • Said support element 15 can also be coupled with the cup 7 by a frusto-conical projection realised on the concave surface of the same, with a matching cavity.
  • basic feature of the present invention is that it permits recovering damaged bone tissue, also due to disassembled fractures, promoting vascularization.
  • a first advantage of the present invention is the fact that it permits faster recovery time.
  • a second advantage of the present invention is that prosthesis, having the minimum dimension, permits an optimum view of where fixing on the rear part the rotator cuff, and proper orientation of cartilaginous surface.
  • providing a reduced number of elements permits a quick choice and assembling of prosthesis elements better conforming to the patient anatomy, with a high adaptability to different patients.
  • a third advantage of the present invention is that of permitting reconstruction of large and small tuberosity.

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  • Health & Medical Sciences (AREA)
  • Orthopedic Medicine & Surgery (AREA)
  • Cardiology (AREA)
  • Oral & Maxillofacial Surgery (AREA)
  • Transplantation (AREA)
  • Engineering & Computer Science (AREA)
  • Biomedical Technology (AREA)
  • Heart & Thoracic Surgery (AREA)
  • Vascular Medicine (AREA)
  • Life Sciences & Earth Sciences (AREA)
  • Animal Behavior & Ethology (AREA)
  • General Health & Medical Sciences (AREA)
  • Public Health (AREA)
  • Veterinary Medicine (AREA)
  • Prostheses (AREA)
US11/920,753 2005-05-27 2006-05-26 Osteosynthesis modular prosthesis, particularly for humerus osteosynthesis Expired - Fee Related US8097040B2 (en)

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IT000265A ITRM20050265A1 (it) 2005-05-27 2005-05-27 Protesi modulare perfezionata per osteosintesi, in particolare per l'osteosintesi dell'omero.
PCT/IT2006/000396 WO2006126238A2 (en) 2005-05-27 2006-05-26 Improved osteosynthesis modular prosthesis, particularly for humerus osteosynthesis

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WO2006126238A3 (en) 2007-05-18
US20090105838A1 (en) 2009-04-23
WO2006126238A2 (en) 2006-11-30
ITRM20050265A1 (it) 2006-11-28
EP1903993B1 (de) 2013-07-17
EP1903993A2 (de) 2008-04-02

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